It’s that time of year again, the flu season is coming. In Southern California it tends to be strongest from January to March. Primary care offices, urgent care facilities, and emergency departments will see their visits increase on an almost daily basis. So let’s talk about “The Flu.”

Influenza is a respiratory disease caused by infection from the influenza virus. There are several types of influenza viruses, but the most important ones from our perspective are Influenza A and Influenza B. The “swine flu” virus, H1N1, is an Influenza A virus.

The typical presentation of flu includes fevers, fatigue, body aches, cough, runny nose, headaches, sore throats. If you are paying attention you’ll see that these symptoms are very commonly found in a variety of viral illnesses, including colds, pharyngitis, ear infections, and bronchitis. One of the key presenting factors to help us diagnose flu are the severe body aches, or myalgias. These are not usually found to the same degree in other viral illnesses.

When patients present to their doctor with symptoms of flu, the diagnosis is usually called “influenza-like illness.” The only way to diagnose true influenza is with a nasal swab to culture the virus. In 2009, during the early part of the swine flu “epidemic,” the CDC was collecting samples from physicians to help determine the distribution of H1N1 in the population. It took a “Freedom of Information Act” filing to get them to release the data, and here’s what is showed:

In California, out of 13,704 specimens only 2% were positive for H1N1, and only 12% were positive for other flu viruses. This meant that 86% of them were negative for any flu virus.

In the other states the negative findings were similar, ranging from 83% to 97% of samples being negative for flu virus

This becomes important because we are attempting to make sure that we are looking at the body from a holistic, natural perspective. One of the keys to managing flu infections in the medical world is the vaccination program. The vaccine is only modestly effective in most patients, with little data supporting its use in healthy people, including elderly and children. But if 83-96% of influenza-like illnesses are negative for influenza virus, even in the most effective situation the vaccine would not be able to prevent these infections. In people who have pre-existing lung problems such as asthma, emphysema, or cystic fibrosis the vaccine has been shown to reduce pneumonia infections and hospitalizations

So if the vaccine is ineffective, then how do we prevent ourselves from “catching” the flu? One of the most effective strategies is basic hygiene. Hand washing, not coughing on others, and using a mask if necessary are all basic strategies that have been shown to be most effective at preventing spread of the influenza virus, as well as other viruses.

As we recall, the Osteopathic philosophy places an emphasis on the body’s response to an insult, in this case a virus landing on our mucous membranes in the nose or mouth. So our approach is to try to boost the natural response, called the innate immune response, to outside invaders.

One strategy includes watching what you eat/drink and checking your supplements. In a 2010 study in Japan, schoolchildren who took 1200 IU/day of Vitamin D had a 58% relative risk reduction compared to placebo for laboratory confirmed influenza A infections. This compares quite well with the CDC’s stated efficacy of influenza vaccines which is in the range of 50-70%. If you are supplementing your Vitamin D via sunlight this can be a challenge during the winter months. In fact, some have proposed that influenza infections be seen as a symptom of Vitamin D deficiency related to decreased sunlight exposure in the winter months.

Sugars can lead to increased inflammation and decreased immune response, so maintaining your avoidance of simple and added sugars is critical. Vitamin C, found in many citrus fruits as well as most supplemental vitamins, is also effective at boosting the innate immune response to viral invaders.

Finally, if for some reason you are unable to respond to viral exposure and are now “sick” the basic rules of hygiene apply. Lots of fluids, rest, sunlight (Vitamin D), hand washing, masks. OMT can also help to stimulate the lymphatic system and improve overall functioning of the body. During the Spanish Flu epidemic of 1918 (the last big swine flu outbreak, BTW) patients who received Osteopathic treatment had a much greater chance of survival than those who just received allopathic care. Data collected by the AOA at the time showed a death rate for DOs patients of 0.2% compared to the documented rate of 12-15% for standard care.

So, to sum up, I think that it’s important to recognize your risk factors going into “flu season” this year. If you are at risk, including chronic lung disease, then the flu shot may help reduce your chances of pneumonia or hospitalization. If you are otherwise healthy please continue to do those things to keep yourself healthy this year, including supplementing with Vitamin D. If you are going to be around people who are sick, hand washing, and maybe masks if those around you have coughs.

With flu and cold season coming up, I thought it would be a good time to discuss how an osteopathic physician looks at infections. The standard medical approach to infections is that they are “caused” by bacteria or viruses (lets call them pathogens) and you need antibiotics or antivirals in order to recover from the infection. This viewpoint is based primarily on the work of Louis Pasteur, a French microbiologist during the mid- to late- 19th century. He established that bacteria were present in disease states. During the next 150 years, medicine has focused on these pathogens, and medical research has searched for more and more powerful drugs to kill them.

What is lost in this analysis, however, is the role of the patient in infections. Pathogens (bacteria and viruses) are around us all the time. They line the surfaces of our body, and the environments around us. Why, then, are we not constantly sick? A peer (and rival) of Pasteur, Antoine Bechamp , postulated that the role of the pathogen in disease was minimal; it is the state of the terrain (body) which determines whether pathogens will thrive and “cause” infections. In other words, a sick body will allow bacteria or viruses to grow, and the outward presentation is an infection. Treatment of the patient, if it focuses simply on killing the pathogen, will not result in a healthy body. One needs to dig further to find out why that particular patient presented with an infection.

Around the same time period in America A.T. Still was formulating his philosophy of Osteopathy, which he envisioned as a complete system of medical care which placed a prime emphasis on the patient instead of the disease. He looked specifically at the role of the musculoskeletal system in producing an environment where disease can take place. When he was asked his impression of the so-called “germ theory” of Pasteur , he stated that it was fine if people wanted to say that bacteria were present in disease, but that still doesn’t explain why a particular person is sick while another is not. He was adamant that disease was only an effect, and the presence of germs were another effect, of a problem within the body. Still focused on the musculoskeletal system, as a method of treatment, but he understood the importance of the circulatory, respiratory, and nervous systems in maintaining the body’s ability to fight off disease. Over the last 134 years science has filled in many of the gaps, and given us a clearer picture of how these systems work together to promote homeostasis (or the tendency for the body to be healthy).

Today traditional or classical osteopath are still utilizing these concepts to help patients fight disease. While we wouldn’t argue that antibiotics are necessary at times, our first approach is to help augment the body’s normal immune response. This might be through improving nutrition, using vitamins or herbs if necessary; it might involve helping to remove stress from the body, either external (work, family, etc.) or internal (strains in the musculoskeletal system, pain, etc.); it usually will involve manual treatment aimed at improving lymphatic flow (the lymphatic system is the “garbage collection system” of the body, collecting pathogens, dead cells, antigens, etc. and bringing them to the immune system for analysis). Only if those methods fail will we resort to killing pathogens with drugs, and even then we will still emphasize these other factors in disease as well.

A case study might be relevant here. This is one I published in California DO magazine in the spring of 2007. The case involved a young female patient who presented to the hospital with complaints of right back/flank pain. She had been previously treated with antibiotics for a presumed kidney infection. In the hospital she was found to have a right sided pneumonia and her urine was without infection. She was started on antibiotics, appropriately, as she had a fever and was showing signs of systemic or blood infection. This treatment, though, did not give us an indication of why she was sick, nor how to best make sure she wouldn’t get sick again. I was called to evaluate her from an osteopathic perspective.

When I asked about previous traumas, she initially denied anything significant. On examination, I found that the right lower ribcage was depressed and did not move when she took a breath. The right diaphragm (the muscle which separates your abdomen from your chest and causes you to breath ) was also restricted and didn’t move very well when she breathed. On further questioning she remembered that she had been involved in a car accident several months ago, and the seat belt had tightened against the right side of her rib cage, causing a bruise.

Now the situation was becoming clearer. She had had a trauma which impaired her ability to take a deep breath. This had set up a situation where bacteria, which are normally present in the lung, were able to overgrow and lead to an infection. The infection in the lung irritated her diaphragm, causing the flank pain she had initially presented with. The antibiotics would have killed off the bacteria in her lung and “treated” the infection, but without treating the musculoskeletal system the predisposing situation would continue to be present, and she was at risk for further infections. Taking a whole body approach allowed us to help her return to a greater state of health.

It is clear that antibiotics are occasionally required to treat infections, especially when the natural defenses are so diminished that the patient is at risk of overwhelming infection. Our goal, as osteopathic physicians,is to get deeper into the problem. If possible, we want to treat when the infection is early enough to augment the natural responses and avoid medications. Even in situations where medications are required, the osteopathic philosophy requires that we treat the precipitating cause, wherever the location, and allow the natural health we all possess to thrive.

Osteopathy vs. Cranio-Sacral Therapy

Many people are confused about the difference between an Osteopath who practices cranial osteopathy and a cranio-sacral therapist. The assumption is that they are the same thing, or at least have the same training.

Cranio-sacral therapists are often physical therapists or massage therapists who decide to take additional training in cranio-sacral therapy (CST). Before we go further I would like to compare the history of CST with Osteopathy in the Cranial Field (OCF).

In the early 1900s an osteopath named William Garner Sutherland began a private study of the motions of the bones of the cranium. He had been struck by an idea as a student that the bones of the head were beveled as if to indicate motion. He spent the next 20 years or so trying to prove himself wrong. Through a detailed examination of the anatomy of the skull, followed by a series of experiments on his own head and on his patients, he became convinced that there was a subtle motion of the head which could be palpated with experience; and that distortions of the joints between the bones of the skull would create problems in the machine of the body just as distortions of the joints of the body create problems. His treatments were gentle, almost imperceptible movements aimed at restoring free motion of the skull. Dr. Sutherland went on to spend the last 30 years of his life teaching others to carry on his work, and now OCF is taught in all osteopathic medical schools, and tested on the national licensing exams. There are two organizations dedicated to research, application, and teaching of the cranial concept, the Cranial Academy and the Sutherland Cranial Teaching Foundation.

Dr. John Upledger was a practicing Osteopath in Michigan when he attended his first OCF course. He began practicing, and researching, the motion of the cranial bones. He later decided to rename his technique CST and begin to teach it to anyone who applied for his courses. Because he is not teaching to physicians, Dr. Upledger does not teach diagnosis, nor do his students learn how to apply specific approaches to specific diseases. They are taught that intention is the key to a safe treatment but due to their lack of osteopathic training they are not able to handle the possible side-effects of their treatments, especially if they are not specific to the problem.

I have put together a table which outlines some of the differences between OCF and CST. I would recommend that if you have a problem for which you think cranial treatment might be indicated, search out a good Osteopath in your area. You can look here or here for a qualified physician.

One Response to “Osteopathy vs. Cranio-Sacral Therapy”

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Therapist:
July 23rd, 2009 at 2:04 amIs cranio sacral therapy really proven? I do know of a patient of mine who got it done for fibromyalgia with adverse effect. A lot of evidence is based on hearsay. It is dangerous when practised by rookie practitioners. It is not an effective tool in therapy for depression, stress relief, migraines etc.Therapist: I agree that craniosacral could be dangerous in the wrong practicioner’s hands. That is why I would encourage that anyone who is looking for this type of approach to their problems would look for an Osteopathic physician who is trained not only in the manual approach but also in the relevant anatomy, physiology, diagnostics, differential diagnosis, and treatments. That physician is in the best position to determine whether manual treatment would be a useful addition to their treatment plan. Thanks for reading!

Osteopathy and Pregnancy

Inspired by a comment that came along yesterday, I thought I’d put together some thoughts on the osteopathic approach to pregnancy. I’ll write on labor and delivery later.

Osteopathy and Pregnancy

Pregnancy is an exciting time for expectant moms, and also a time of great change, both physically and emotionally. Osteopathic physicians (DOs) are uniquely qualified to intervene and assist in this wonderful time. In fact, a study in the Journal of the American Osteopathic Association in 2003 showed that women who received Osteopathic care during their pregnancy had lower rates of cesarean section delivery, preterm delivery, umbilical cord prolapse, and meconium stained amniotic fluid compared with women who did not receive Osteopathic care.

As the baby grows, the uterus expands around it. This causes the center of gravity to shift, and the mother-to-be has to adjust her posture to accommodate. In an ideal situation the body would adapt to the changes it is subjected to, and the pregnancy would be uneventful. Unfortunately, most of us have pre-existing imbalances in the skeletal system, which Osteopaths call Somatic Dysfunction. These imbalances prevent the body from making the appropriate changes, and pain is the result. The job of the Osteopath is to find these Somatic Dysfunctions and, through a series of gentle techniques, remove them, thereby allowing the body to respond and change with the ever expanding uterus.

Unlike other practices, there are no pre-defined “techniques” or movements in Osteopathy. The Osteopath uses his or her hands to examine all parts of the musculoskeletal system looking for Somatic Dysfunction. Evidence of Somatic Dysfunction could be changes in the texture of the skin or underlying muscles, asymmetric positioning of the joints of the spine or appendages, restricted responses to active or passive motion testing, or tenderness in specific anatomical locations. Any one or all of these findings might be present, and their presence is an indication for Osteopathic treatment.

Other symptoms of pregnancy which are amenable to Osteopathic treatment include pelvic, back or neck pain; swelling of the extremities; varicosities (enlarged veins) in the legs or vulvar area; hemorrhoids; and mastitis or milk duct blockage. Often women will continue to have back pain long after their children are born. This is because the lax ligaments which allow the pelvis to expand and the baby to pass through can become strained if the joints are not positioned correctly before they tighten again. Osteopathic treatment post-partum, therefore, can help prevent chronic back pain after pregnancy. Women who have inductions of labor have a more forceful and often more difficult labor and may have more Somatic Dysfunction following birth. Women who have C-sections not only have to contend with the changes related to pregnancy and labor but also major surgery. There are many studies showing the benefits of Osteopathic manipulation following surgery to prevent respiratory infections, constipation, and reduce pain medicine use.

Osteopathic physicians are not only qualified to provide the appropriate manipulative treatment but are also fully licensed doctors, meaning that they can diagnose and treat many of the medical complications which can arise during pregnancy.

4 Responses to “Osteopathy and Pregnancy”

1

Jen:
August 19th, 2008 at 10:17 pmSo many pregnant women I know see a chiropractor. I did myself during my first pregnancy when my baby was breech. What are the differences between how a chiropractor & DO approach and treat pregnant women?

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admin:
August 25th, 2008 at 6:44 pmHi Jen:

I’m putting together a chart which will outline the main differences between a chiropractor and a DO. As far as approaches go, I would tend to say that the chiropractor would look more at the joints and alignment of the spine while the DO would pay more attention to the overall body structure, including the soft tissues, muscles, ligaments, tendons, etc. This means that the treatment from a DO is very different from a chiropractor. My patients who have received both treatments comment on the differences.

The osteopathic philosophy says that we (meaning physicians) can not “correct” the body. All we can do is try to locate and remove blockages to health, and allow the body to make the changes. This means that although you came to the doctor for your headaches, the treatment may result in improvement of your low back pain first, then your menstrual cycle, and lastly your headaches. This is the body choosing how and when to make changes, and it is wiser than we give it credit for in the medical profession.

Please check back and look at the pages for the chart outlining differences between various “bodywork” professions.

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The StillpointOsteopathy and Pregnancy | Joint Pain Relief:
June 8th, 2009 at 11:35 am[…] The StillpointOsteopathy and Pregnancy Posted by root 21 minutes ago (http://lovelessdo.com) Inspired by a comment that came along yesterday i thought i 39 d put together this is because the lax ligaments which allow the pelvis to expand and the baby to pass through can become strained if the joints are not positioned correctly before they tighte Discuss | Bury | News | The StillpointOsteopathy and Pregnancy […]

4

Balham Osteopath:
October 6th, 2009 at 2:24 pmI enjoyed reading your interpretation. A great “in your own words” definition of osteopathy, however you do not explain how treatment takes affect, and what effects you as an osteopath can have on the body. thanksThanks for the input. I have found that it’s hard to explain what an osteopathic treatment is like because it varies so much from practitioner to practitioner. As far as how the treatment takes place, that is also hard to explain because there are so many levels to a treatment, from the direct musculoskeletal changes to the deeper fascial alterations which can affect fluid flow, whole-body tension, and mind-body connections. I really think that the best way to explain an osteopathic treatment is to experience one.

So I tried to update my WordPress blog and managed to wipe out all of my posts and comments. I’ve decided to move the blog here to be hosted on the WordPress site instead of my own. Should keep errors like this to a minimum going forward.

As for the posts, thank God for Google cache! I am able to pull up all of my pages and will be reproducing them here.